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Centre for Dementia Research

Cancer and Dementia in Hospitals Research (CANDEM)

Understanding the cancer treatment and care needs of people living with cancer and dementia in the UK.

Cancer and Dementia in Hospitals Research (CANDEM)

The Challenge

Cancer and dementia are both common conditions in older people. In the UK half of all people with cancer are aged over 75 and there are currently 850,000 people living with dementia. However, we do not know how many people in the UK are living with both conditions. Or what their cancer care and support needs are, or how these could best be met.

This study aimed to identify the size, characteristics, cancer treatment and care needs of people living with cancer and dementia in the UK.

Methods

We undertook two inter-linked studies; a quantitative study (using GP records) and a qualitative study (using interviews and observations).

  • Study One

    We used anonymised data from the GP records of 116,388 people with cancer, dementia, or both conditions living in the UK. We compared data for each group of people, including demographic information (such as gender, age, place of residence) and clinical information (such as comorbidities, visits to the GP, and prescriptions).

  • Study Two

    We used observations, interviews and hospital records to understand the cancer care experiences of 17 people living with dementia and 22 of their families, as well as the experiences of 19 staff members providing support to them. In total, we carried out 37 interviews and undertook 46 hours of observation.

the results

We found that a significant minority of people are living with cancer and dementia; of people aged 75+, 7.5% were living with both conditions. We also found that people living with cancer and dementia differ in important ways from people with cancer alone. For example, they are older, more likely to live in a care home, more likely to have additional comorbidities (alongside having cancer and dementia) and use more healthcare resources (e.g. GP appointments and prescriptions).

Having dementia adds a great deal of complexity to cancer treatment and care. For example, decision making around cancer treatment becomes more complex. There are challenges around capacity, understanding and retaining information, and balancing quality against quantity of life. Cancer clinicians did not always know if someone had dementia and most staff had little or no access to dementia training. However, we also found many examples of cancer services providing a range of approaches to support people with dementia and their families to navigate cancer care. These included consistent staffing across appointments, tailoring of information and appointments to suit the person’s needs and recognition of the need to support and include sometimes highly burdened family members as well as the person with dementia.

Getting the findings into practice

The findings from this study have been used by:

Booklets

We have produced three booklets that present the findings in formats suitable for:

  • People with cancer and dementia
  • Carers of people with cancer and dementia
  • Staff working in cancer services

We would be pleased to hear from any organisations or services who would be interested in or who have used the findings to improve the care and support cancer services they offer to people living with dementia.

Additional Information

  • Griffiths, A.W., Ashley, L., Kelley, R., Cowdell, F., Collinson, M., Mason, E., Inman, H., Henry, A., Farrin, A. and Surr, C. (2021)  Balancing the needs of individuals and services in cancer treatment for people with dementia: a focused ethnographic study International Journal of Nursing Studies. 121: 104006. Published on-line 21.6.21 https://doi.org/10.1016/j.ijnurstu.2021.104006
  • Kelley, R., Surr, C., Griffiths, A. et al (2021) Providing cancer treatment and care to people living with cancer and dementia: challenges and research-based recommendations Cancer Nursing Practice. doi: 10.7748/cnp.2021.e1754
  • Ashley, L., Kelley, R., Griffiths, A., Cowdell, F., Henry, A., Inman, H., Hennell, J., Ogden, M., Walsh, M., Jones, E., Mason, E., Collinson, M., Farrin, A. and Surr, C.  (2021) Understanding and identifying ways to improve hospital-based cancer care and treatment for people with dementia: an ethnographic study. Age and Aging. 50(1): 233-241 Published online 6.11.20 https://doi.org/10.1093/ageing/afaa210
  • Surr, C.A., Griffiths, A.W., Kelley, R., Ashley, L., Cowdell, F., Henry, A., Inman, H., Collinson, M., Mason, E., and Farrin, A.J. (2021) Navigating cancer treatment and care when living with comorbid dementia: an ethnographic study Supportive Care in Cancer. 29(5): pp2571-2579 https://doi.org/10.1007/s00520-020-05735-z published on-line 21.9.20
  • Griffiths, A.W., Ashley, L., Kelley, R., Cowdell, F., Collinson, M., Mason, E., Farrin, A, Henry, A., Inman, H. and Surr, C. (2020) Decision-making in cancer care for people living with dementia. Psycho-Oncology. 29(8): pp1347-1354 https://doi.org/10.1002/pon.5448
  • Surr, C. Kelley, R., Griffiths, A.W., Ashley, L., Cowdell, F., Henry, A., Collinson, M., Mason, E. and Farrin, A. (2020) Enabling people with dementia to access and receive cancer treatment and care: The crucial role of supportive networks. Journal of Geriatric Oncology. 11(7): pp1125-1131 Published on-line 3.4.2020 https://doi.org/10.1016/j.jgo.2020.03.015

This research was led by a team from the Centre for Dementia Research (Professor Claire Surr, Dr Rachael Kelley, Dr Alys Griffiths) in collaboration with Professor Amanda Farrin1, Michelle Collinson1, Ellen Mason1, Professor Fiona Cowdell2, Dr Ann Henry1,3, Hayley Inman4, Amanda Proctor3, June Hennell5, Maria Walsh5, Liz Jones5, Margaret Ogden5.

1 School of Medicine, University of Leeds; 2 School of Nursing and Midwifery, Birmingham City University; 3 Leeds Teaching Hospitals NHS Trust; 4 Bradford Teaching Hospitals NHS Foundation Trust; 5 CanDem Lay Advisory Group

This research was funded by the National Institute for Health Research (NIHR) RfPB programme (project reference PB-PG-0816-20015). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

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